New in the Literature: Parkinson Disease (Clin Rehabil. 2011;25:396-407])

Thursday, July 07, 2011

New in the Literature: Parkinson Disease (Clin Rehabil. 2011;25:396-407])

The empirical evidence in support of the benefits from verbal instructions (verbal commands given by another person) on stride length, gait velocity, and stride variability in people with Parkinson disease is weak, say authors of a systematic review published in Clinical Rehabilitation. The evidence is limited, they add, to short-term stride length improvement from the use of the instruction to take big steps in walking training.

Independent reviewers extracted data from eligible studies from Cinahl, Cochrane, Embase, Medline, PEDro, PsycINFO and Web of Science and assessed methodological quality. The level of evidence was determined by best evidence synthesis based upon the experimental design, methodological quality and statistical findings of individual studies.

One randomized controlled study and 12 non-controlled studies involving 149 participants fulfilled the selection criteria. The 5 types of verbal instructions examined were "take big steps," "walk fast," "swing arms when walking," "count rhythm when walking," and "walk fast with big steps." Best evidence synthesis found indicative evidence in support of the use of the instruction to "take big steps" in walking training for stride length improvement in people with mild to moderate Parkinson disease who were without cognitive impairment. There was insufficient evidence in support of effects on gait velocity and stride variability. There also was insufficient evidence in support of effects of other instructions on any of the gait variables.

Comments

save under research?

Posted by me
on 7/8/2011 5:06 PM

Step estimation seems to work well to automatically increase stride length. First: ask patient to walk in normal fashion and count the number of ipsilateral foot strikes over a measured distance, then secondly; request patient to walk same distance in fewer steps. Count out loud number of ipsilateral foot strikes for immediate feedback. Try it...really works. Once a familiar distance is habituated then transfer distance to other common familiar environmental walking targets. Stride length to leg length ratio is an excellent performance measure vs raw stride length as it relates to leg length measured from the greater trochanter to floor with footwear (Gill,Magliozzi).